Surgery the unkindest cut

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When NSW Public Health spends one-fourteenth of its $10 billion
annual budget on elective surgery, and still feels the need to
ration it by shutting doors for weeks on end, you have got to
wonder what is happening in administration. About 65,000 people in
NSW are awaiting surgery for non-life-threatening conditions, and
the shutdown periods are getting longer. Hospital administrators
this summer will turn off elective surgery for up to six weeks,
adding to the strain created by routine shutdowns throughout the
year. The longer or more frequent the shutdowns, the fewer the
patients relieved of suffering and the lesser opportunity for
training of aspiring surgeons. And why this squeeze? Because among
the demands on the hospital dollar, elective surgery is the easiest
tap to turn on and off, if only for hospital administrators.

This is management by expediency, the easy way out for
administrators who immediately pull the handbrake on elective
surgery each time costs get out of control elsewhere. Their actions
suggest demand for elective surgery is as unforeseeable as the
weather. But Patrick Cregan, who headed a review of the state's
surgical services, says elective surgery should be very predictable
and carefully planned. "The problem is the surgical patients become
the financial buffer of the system," says Dr Cregan, whose team
will advise the Health Minister, Morris Iemma, on more accurate
estimates of surgical needs, the resources needed to meet demand
and the effectiveness of waiting list reduction programs.
Deteriorating situations in hospitals give the advisers much to
work with.

Circumstances vary across hospitals. Nepean Hospital, for
instance, suspends planned surgery for about 12 weeks a year,
including breaks over Christmas, Easter and other school holidays.
Surgeons are expected to give up a day's worth of operating every
two months to make room for more emergency surgery. The Royal North
Shore Hospital closes elective surgery at 3pm daily. Surgery is
routinely held over when intensive care beds - prerequisites for
cardiac and some other elective surgery - are taken up unexpectedly
by more urgent cases.

No one suggests it is easy striking the right balance. By its
very nature, injury can hit unexpectedly and hospitals must be
geared for worst-case scenarios. This is burdensome on budgets. It
falls to administrators, however, to provide better for those whose
lives are not immediately at risk but whose discomfort or
immobility is prolonged heartlessly by tricks of the management
trade.

Perhaps more money is needed from the Government, which topped
up the elective surgery kitty with another $35 million just this
year. But waiting lists have not improved over nine years of huge
hikes in health spending. Fixing up the financial housekeeping
would be a better starting point.

A question of privacy

Most people would cheer Liz Munro. By accessing confidential
information, she exposed a pedophile and protected children in her
care. Yet Ms Munro's actions raise serious questions about the
privacy of government information.

Ms Munro, a Sydney probation and parole officer, was also
president of the Scottish Dancing Association in NSW when, in
October 2002, she became suspicious of Andrew Manners, who was
teaching Scottish dance in Sydney. She searched the Corrective
Services Department database and discovered that Manners was on
parole for offences against minors in Queensland and was banned
from going near children. She confronted Manners and alerted his
parole officer and some parents of his students. Manners was
arrested the next day for breaching parole. He later confessed to a
further offence involving a 10-year-old girl. The following
February Ms Munro accessed the department's records again, this
time to get the names of those visiting Manners in jail. She
contacted one visitor, a member of the Manners family, to tell her
of Manners's offence against the 10-year-old. (Just why the family
would not already have known is not clear.)

Manners complained to Corrective Services and Ms Munro was
counselled and given a warning. Manners then complained to the
Administrative Decisions Tribunal. It has found that as a parole
officer, Ms Munro was entitled to access the initial information
about Manners, even though she was not Manners's parole officer.
However, it found that she was "acting in her private capacity" in
giving that initial information to parents, and again in accessing
the information about Manners's visitors and contacting one.
Strangely, it held that these "private" actions were not the
responsibility of the department. The department's responsibilities
were to put warnings on its computers about unauthorised access and
this it had done.

This is unsatisfactory. Putting aside questions about whether Ms
Munro needed to access any files at all - could she not have taken
her initial suspicions about Manners to the police? - the wider
issue raised by the case is why Corrective Services records are not
restricted to those who need them. That would force others to make
their ad hoc inquiries through proper channels. All government
departments should encode data so it can be used only for its
intended purpose. Anything less is an abject failure to protect
privacy - and an invitation to blackmailers and vigilantes.
Government departments might cast their minds back to 1995 when the
Sydney detective Said Morgan retrieved from a police computer the
address of a man who had molested his family, and shot him dead. A
jury acquitted Mr Morgan of murder and manslaughter charges.